New Patients

Registering with the Practice

Our practice list is currently open to new patients within our boundaries.

You can pick up a registration pack from either surgery. The registration pack also includes other optional forms such as Applications to Online Services and Electronic Prescription Services Request. More information about these forms can be found on our website or in the pack itself.

New Patient Registration Form

Patient Details

Use this form to register for General Medical Services at Trinity Medical Centre and Sandal Castle Medical Centre. A form must be completed for each patient wishing to register for family doctor services. For our full privacy notices and information on the data we collect, please see our website;
Title

Gender
DD/MM/YYYY
IMPORTANT: THIS IS NOT YOUR NATIONAL INSURANCE NUMBER. Please contact your previous surgery to obtain. https://www.nhs.uk/using-the-nhs/about-the-nhs/what-is-an-nhs-number/
Town/City and Country
**If you were born outside of the UK please enter the date you arrived in the UK.
Please state main spoken language in the free text box below if not listed.

Previous GP

Please help us trace your previous medical records by providing the following information

Accessibility

Do you consider yourself to have a disability?

If you answer YES please complete the rest of this section.
Details of impairment
Written Communication support

Verbal/Face to Face communication support

Carers

This information helps us support our patients and their carers in the best way possible. If you need further advice on Carers in the Wakefield area please visit: https://www.carerswakefield.org.uk/
Are you a carer?
Is someone a carer for you?
If you answered yes to having a carer,you can give us their name and contact number if you wish for us to have this on your record.

Health Information

Please provide this in cm/m
Please provide this in kg
How often do you drink alcohol?
How many standard alcoholic drinks do you have on a typical day when you are drinking?
How often do you have 6 or more drinks on one occasion?
Smoking Status
For information and support to stop smoking, please visit Yorkshire Smoke Free https://wakefield.yorkshiresmokefree.nhs.uk/
Do you have a drug addiction?
If you answer yes. please give information below
Please give information about addiction issues and if you are engaged in a substance misuse service.

Medical History

Are you currently under any hospital care?
Do you have any known allergies?
Please list your medication here
Please list any health problems or long term conditions such as Asthma, Diabetes and any other relevant medical information
Have any of your immediate relatives (brothers/sisters/parents) had any of the following;

Women's Health

Optional
What is your current method of contraception?
Are you currently pregnant?

Data Sharing

Please complete this questionnaire to ensure we can record your preferences for the use of the data we store and share about you. For more information please see our practice website.
Consent to SMS messaging
The practice stores your mobile number to ensure we can contact you when we need to. We would also like to use this to send you important reminders such as appointments or other important notices. We will never share your mobile number and we will only use it for appropriate reminders.
Consent to Email Messaging
The practice stores your email address to ensure we can contact you this way when we need to. We would also like to use this to send you important reminders such as appointments or other important notices. We will never share your details and we will only use it for appropriate reminders.
Summary Care Record (SCR)
NHS in England use the Summary Care Record in emergency care to ensure those caring for you have enough information to treat you safely. For more information on your health records please see: https://www.nhs.uk/using-the-nhs/about-the-nhs/how-to-access-your-health-records/
Do you consent to the sharing of data recorded at Trinity Medical Centre with any other organisations that are involved in your direct care?
Our practice uses a computer system called SystmOne that allows the sharing of full electronic records across different care services that you use. You can choose to permit or restrict access to the information entered into your record at each organisation that accesses your record. You will be asked to give record sharing consent at each organisation at which you receive care. Your consent can be changed at any time.
Do you consent to Trinity Medical Centre being able to view information that is recorded at other care services that may care for you (and where the patient has agreed to make the data shareable)?

Online Services

As part of your new patient registration (and provided we can verify your identity) we can offer you access to online services. For more information on this service please see the practice website: http://www.tmcwakefield.co.uk
Would you like to be registered for online services to enable you to order your medication, book appointments and view your record?

GP Boundary Map

The RED line is our extended boundaries which is only available to patients who are already registered with the practice.

Temporary Residents

If you are only residing in the practice area for a short period of time for example if you are staying with family or working in the local area (for a period of up to 6 months) we can register you as a temporary patient with the practice. This will ensure that your complete medical records stay with your usual GP practice but we will be able to treat you for any urgent and non-urgent care needs that you have.

6 months from the date of registration you will be removed from our practice list and any information we have recorded will be sent to your usual GP (if it hasn’t already) or back to NHS England.

For more information about registering with us or to view the full registration policy, contact our Admin Team by email trinity.medicalcentre@nhs.net